CARC 19
Belongs to workers' compensation
The payer treats this as a work-related injury and the liability of the workers' compensation carrier.
Why you actually get this
- The injury was work-related and was billed to the health plan.
- The patient did not disclose that the injury happened at work.
How to check whether it’s correct
- 01Establish whether the injury was work-related and whether a claim was filed.
- 02Identify the workers' compensation carrier and its filing limit.
Rarely worth appealing
Nothing to appeal with the health plan. Redirect to the correct carrier quickly — the timely-filing clock there has been running since the date of service.
Often arrives with
Seeing a lot of these?
A single denial is a claim to work. A pattern of the same denial is a process to fix, and the two need completely different responses. A free panel reads ninety days of your claims data and shows which codes actually recur for you.
Claim Adjustment Reason Codes are maintained by X12 as External Code List 139. The official description of this code is theirs and is not reproduced here. Check the authoritative list for current wording and status.